EXTERNAL APPEALS

Compliance-driven reviews that meet federal and state requirements

FEDERAL AND STATE EXTERNAL APPEAL SERVICES

As a payer, your organization is committed to providing high quality care to your members that is medically necessary, appropriate and will lead to better outcomes, while controlling overutilization. Federal and state-mandated external appeals are the final stage of the decision-making cycle for a small percentage of health plan members, but critical to upholding the integrity of that commitment.

AllMed provides external appeal services to leading payer organizations of all types, in fulfillment of state and federal regulations. These comprehensive reviews are performed to the highest standards of quality. Determinations are made by our leading panel of board-certified physician peer reviewers, who are licensed and in active practice.

External appeals require extra care in gathering provider and member documentation, ensuring that all evidence is brought to bear on each case determinations. AllMed follows strict protocols for member and provider communication, ensuring these standards are met.

Smiling female doctor standing with medical colleagues

MedReview

We process all our federal and state external appeal reviews through our MedReview workflow following all applicable regulations. We monitor and manage our review service through our in-house compliance program. 

SUPERIOR QUALITY THAT MAKES A DIFFERENCE

All of our services, including external appeals, are deployed through PeerPoint, AllMed’s advanced medical review portal, which embeds healthcare intelligence and automation tools that produce the highest quality reviews at industry-leading turnaround times and costs.

Most importantly, our dedicated team is driven by a mission to uphold the integrity of the process for all parties concerned. Our commitment to the highest quality and standards of service excellence has distinguished AllMed from other IROs, through the partnerships that we forge with our clients.

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